Injectable medications are frequently utilized by healthcare providers (caregivers) in the care of patients in the hospital, in pre-hospital emergency medical services and at alternate care sites (including skilled nursing facilities, home health and hospice settings). Caregivers can include medical doctors, registered nurses, EMS paramedics, dentists and other licensed healthcare practitioners. Accurate documentation of what, when and how much medication is given to a patient is required by healthcare institutions, governmental agencies and regulatory oversight agencies. Many of the medications provided are controlled substances which require additional levels of controlled access, accurate administration documentation and the secure disposal of unused medication and medication containers. Despite the additional access controls provided by automated medication dispensing units on hospital floors, instances of “drug diversion” continue to rise. While most hospitals have automated medication dispensing units on floors to keep drugs locked and near patients who need them, oftentimes, two employees are required to input security IDs to retrieve and log the disposal of various potent drugs and narcotics. However, such security measures may not extend to all areas where the medications are distributed on the floor of a hospital or in the field during emergency medical treatment.
Patient safety and liability issues are increasing the call for pharmaceutical compliance efforts. Hospitals must have procedures in place that include, among other things, validation of a medication's use through patient medical records and a regular review of dispersal records from automated dispensing units against inventory. All narcotic waste is expected to be documented on a Controlled Drug Report by the medication administration nurse and one nurse witness. Although a witness is required for the wastage of controlled substances, the caregiver diverting the medication may choose one of several alternatives and may not get a witness. There may be a request to verify a signature from another nurse without witnessing the actual discard, the diverter may substitute the wasted controlled substance with a clear solution and seek a witness as they discard the clear solution, or document the patient was given an additional dose from the leftover medication. The provider may later request a verifying signature from another provider on the shift with the excuse that they were too busy to get a signature at the time the medication was discarded.
Most drugs are packaged for adults and frequently, patients are administered less that the full amount of drug in a medication container, resulting in unusable drug that becomes waste. Additionally, there is almost always waste in pediatric drug dispensing because most drugs are packaged for adult doses. The process of disposing and documenting controlled substances as waste consumes time and resources. Most practitioners would agree that verifying the dose of a controlled substance prior to administration is a practice standard that should be upheld. But the second part of the verification, verifying remaining medication in a vial, ampoule, bag, syringe or other medication container with residual unused medication to be disposed of as waste is a step identified as cumbersome and easily neglected by practitioners if they are too busy. Disposing of all controlled substances should follow rigorous procedures, not require unnecessary steps for a caregiver and witness to verify actual wastage, be a simple and easy process to follow and include rigorous tracking and reporting procedures.